Provider Demographics
NPI:1386191138
Name:SANTIAGO GONZALEZ, HECTOR LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:LUIS
Last Name:SANTIAGO GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 LBJ FWY STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-6065
Mailing Address - Country:US
Mailing Address - Phone:214-358-2300
Mailing Address - Fax:214-579-6941
Practice Address - Street 1:2005 W PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2034
Practice Address - Country:US
Practice Address - Phone:214-358-2300
Practice Address - Fax:214-579-6984
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV0534207RN0300X
TXBP10079283207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV0534OtherMEDICAL LICENSE